SAN ANTONIO
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VOLUME 70 NO. 6
Generational Perspectives 2
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Generational Perspectives 2 Our Little Medical Family By Jaime Pankowsky, MD ..................................14
Familial Doctoring By Helen Pankowsky, MD ....16
Multigenerational Medicine: Herb and Sylvia Brown and their Extended Family By Herbert P. Brown, MD ...................................17
A Father’s Influence By Joseph D. Diaz, MD ......................................22
BCMS President’s Message ..........................................................................................................8 BCMS Legislative News ..........................................................................................................................10 BCMS Alliance.........................................................................................................................................12 Feature: In Real Time, Part 6 By Rajam Ramamurthy, MD ......................................................................26 Legal Ease: Naked in Vegas. Now what? By George F. “Rick” Evans, Jr., .............................................30 Opinion: Don’t go to a freestanding ER if you have the flu By Bernard Swift, Jr, DO, MPH, CEO .........32 Public Service: Who’s on first? By Kirby Turner, MD, DARPN, FACFP.....................................................34 BCMS Circle of Friends Directory............................................................................................................36 Health: Yoga as Medicine By Hetal Nayak, MD ......................................................................................40 In the Driver’s Seat...................................................................................................................................43 Auto Review: 2017 BMW M2 By Steve Schutz, MD ...............................................................................44
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VOLUME 70 NO. 6
San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS.
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Pictured on the front cover are members of the Herff family, a prominent family of doctors in San Antonio (and descendants of BCMS founder Dr. Ferdinand Herff) including (clockwise from upper left) J.B. Herff, MD; Adolph Herff, MD; F.P. Herff, MD; and A.F. Herff, MD.
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Growing up in the medicine lifestyle By Prash Rao, MD ..............................................24
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BCMS BOARD OF DIRECTORS ELECTED OFFICERS Leah Jacobson, MD, President Adam V. Ratner, MD, Vice President Sheldon Gross, MD, President-elect Jayesh B. Shah, MD, Immediate Past President Gerald Q. Greenfield Jr., MD, PA, Secretary John Robert Holcomb, MD, Treasurer
DIRECTORS Rajaram Bala, MD, Member Lori Boies, PhD, BCMS Alliance President Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member George F. "Rick" Evans Jr., General Counsel Vincent Paul Fonseca, MD, Member Michael Joseph Guirl, MD, Member John W. Hinchey, MD, Member Col. Bradley A. Lloyd, MD, Military Rep. Rodolfo Molina, MD, Board of Mediations Chair John Joseph Nava, MD, Member Gerardo Ortega, MD, Member Robyn Phillips-Madson, DO, MPH, Medical School Representative James E. Remkus, MD, Board of Censors Chair Ronald Rodriguez, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative David M. Siegel, MD, JD, Member Bernard T. Swift, Jr., DO, MPH, Member
CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer
CHIEF OPERATING OFFICER Melody Newsom Alice Sutton, Controller Mike W. Thomas, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director
COMMUNICATIONS/ PUBLICATIONS COMMITTEE Rajam S. Ramamurthy, MD, Chair Kenneth C.Y. Yu, MD, Vice Chair Carmen Garza, MD, Community Member Kristi Kosub, MD, Member Lauren Michael, Medical Student Sara Noble, Medical Student Fred H. Olin, MD, Member Jaime Pankowsky, MD, Member Alan Preston, Community Member Adam Ratner, MD, Member David Schultz, Community Member J.J. Waller Jr., MD, Member Jane Yoon, Medical Student
6 San Antonio Medicine • June 2017
PRESIDENT’S MESSAGE
“Would I Do It Again?” By Leah Jacobson, MD, 2017 BCMS President
"Would I do it again?"— I would hope that I would. I bet I am not the only physician that has pondered that important question. With our intense training and extensive commitment in time, money and energy, I have more than once wondered whether I could be happy doing something else. My associates and I have joked that if the “medicine-thing” doesn’t work out, we are going into party planning. I have to believe that a higher power drove me into medicine, in particular pediatrics. I have wanted to be a pediatrician since I was 8 years old. I had a goal. I was driven. Four years of college; four years of medical school, then residency. The residency did not go quite as smoothly. My son, Andrew, was born with VATER’s Association when I was a fourth-year medical student. He had numerous complications and was in the hospital quite a bit. All in all, my pediatric residency ended up being about four years, instead of the usual three. There were so many times it would have been easier to quit or take an “extended break,” but something in me, as well as the support of family and friends, pushed me on. Little did I know that my medical training would play such an important role in my everyday life, having a better knowledge to help my son. On the flip-side, my son and daughters have taught me so much as well. I do believe that medicine still offers men and women a wide range of career options (full-time vs. part-time, private practice vs. hospitalist vs. academics, solo-practice vs. small- or large-group practice). There are not many professions that offer such a diversity of options. Up until about five years ago, I had the luxury of working part-time (in a clinical academic setting and in private practice), both by personal choice and somewhat out of necessity. This was so that I could maximize and enjoy my most important role as a mother. It has been important to me to be able to take my children to dance, piano, soccer/softball, etc. I have enjoyed having the opportunity to be involved in their classes and activities. I know it will not be long before the youngest does not want me around. This work schedule also afforded me the ability to be available to schedule and attend most of my son’s doctor and therapy appointments, not to mention being able to be there when he was in the hospital or going through recovery. 8 San Antonio Medicine • June 2017
Ironically, at this impasse of health care reform, I recall a time when our office had two college students shadowing my colleague and I. These two young ladies were trying to decide which path in medicine was right for them. One was sure about medical school, and the other was trying to decide whether medical school or physician assistant school was the right choice for her. It was an interesting time of reflection for me. How do you encourage them to go through what you did and not really know what is going to happen with our healthcare system? With the presumption that there is going to be a tremendous influx into the healthcare system of individuals, there is definitely going to be a need for both physicians and mid-level providers (PA’s and NP’s). It is both an exciting and somewhat frightening time to be in the field of medicine. As an aside, I have to mention my involvement in organized medicine. I got involved when I started medical school in the Summer of 1990. I joined the Texas Medical Association (TMA), and the American Medical Association (AMA), as well as BCMS (Bexar County Medical Society). I felt that it would give me a better understanding of a different aspect of medicine-politics, public policy, etc., as well as afford me the opportunity to meet a variety of physicians and mentors. I have continued to be active in organized medicine and feel that it is important that we all get involved at some level, especially at this important time in health care reform. I would like to continue to encourage all physicians, in particular the women, to get involved! It can be through your specialty society or your main hospital and at the local, state or national level. Everyone counts!! You can’t be heard if you don’t say anything! In closing, I can honestly say that I would choose medicine again. It is a part of me, and while it doesn’t completely define me, it is definitely a big piece! I cannot imagine not having this background to aid me in my everyday life. The field of medicine and how we practice has definitely changed since I attended medical school, and it will continue to evolve over the next several years. I will continue to stay involved in medicine and I hope you will too! Sincerely, Leah H. Jacobson, M.D.
BCMS LEGISLATIVE NEWS
Last First Tuesdays held May 2 85th Legislative Session adjourns May 29 By Mary E. Nava, MBA, Chief Government Affairs Officer and Lobbyist The final First Tuesdays of the 85th Legislative Session concluded on May 2. Many thanks to the following physician and Alliance members who attended: Physicians — Pam Hall, MD; Jim Humphreys, MD; Leah Jacobson, MD; Alex Kenton, MD; Alisha King, MD; Ninza Sanchez, MD; and Jayesh Shah, MD; Alliance members included James Deurr and Jennifer Shepherd. At the time of this writing, there were less than 20 days left in the 85th regular Legislative Session, which was scheduled to end sine die on May 29. A number of bills are still in the pipeline that are of importance to medicine covering a variety of topics, including: scope of practice, Medicaid, the state budget, GME, public health,
step therapy, surprise billing, prescription drug monitoring program, network directories and telemedicine. Stay tuned to this column for information updates on the 85th Legislative Session wrap-up, the outcome of legislation of importance to medicine and results of bills signed into law or vetoed. A complete wrap-up will be coming soon. For local discussion on these and other legislative advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava, BCMS chief government affairs officer and lobbyist at mary.nava@bcms.org.
BCMS physicians and Alliance members meet with Rep. Diana Arevalo (Dist 116) outside the House of Representatives in the Texas Capitol on May 2 during First Tuesdays.
BCMS physicians stop to visit with Rep. Ina Minjarez (Dist 124) (standing center in dress) and her chief of staff, Nar Dorrycott, during the May 2 First Tuesdays at the Capitol.
Members of the Bexar and Travis county medical societies, along with BCMS Alliance members and staff pause for a group photo with Sen. Donna Campbell, MD (Dist 25) (standing center in black and white dress) during the last First Tuesdays visit to the Capitol on May 2.
BCMS physicians standing (l-r) with Sen. Jose Menendez (Dist 26) (center) are: Leah Jacobson, MD; Alex Kenton, MD; Jim Humphreys, MD and Jayesh Shah, MD
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BCMS Delegation to TMA wraps up House of Delegates business during TexMed 2017
BCMS DELEGATION NEWS
By Mary E. Nava, MBA, Chief Government Affairs Officer and Delegation Liaison TexMed 2017, TMA’s annual meeting, convened May 5-6 in Houston at the beautiful Marriott Marquis Hotel. Leading up to the meeting, the BCMS Delegation to the TMA prepared, reviewed and approved resolutions to be considered by the TMA House of Delegates. In addition, the group put forth two physicians who were on the election ballot for seats on the TMA Board of Trustees and the Texas Delegation to the AMA — John Holcomb, MD and Jennifer Rushton, MD, respectively. Dr. Rushton won election as an alternate delegate to the Texas Delegation to the AMA, in which both David Henkes MD and Jayesh Shah, MD were reelected to their delegate posts, with Dr. Henkes continuing as Chair of the Delegation to AMA. Also, immediately following the conclusion of the business of the House of Delegates, the TMA Board of Trustees convened and Dr. Henkes was named Chairman of the Board of Trustees. In a special presentation during the Caucus meeting of the BCMS Delegation to TMA, BCMS President Leah Jacobson, MD and BCMS Delegation to TMA Chair, Jayesh Shah, MD, presented Dr. Holcomb with the TMA Star Award for his 15+ years of service as Chair of the TMA Select Committee on Medicaid, CHIP and the Uninsured. Additionally, the BCMS Delegation to TMA submitted a resolution honoring Dr. Holcomb for his years of service on the Committee, which was recommended for adoption by the TMA Reference Committee on Financial and Organizational Affairs and was subsequently adopted by the full body of the House of Delegates. Many thanks to the members of the BCMS Delegation to TMA who served as delegates during the two-day business meetings, represented BCMS in reference committee meetings and participated in the elections for office during the House of Delegates proceedings: George Atiee, MD; Chelsea Clinton, MD; Suresh Dutta, MD; John Edwards, MD; Harold Gaskill, MD; Alice Gong, MD; Donald Gordon, MD, PhD; Sheldon Gross, MD; David Henkes, MD; John Hinchey, MD; David Hnatow, MD; John Holcomb, MD; James Humphreys, MD; Leah Jacobson, MD; Relief Jones, III, MD; Wendy Kang, MD, JD; Margaret Kelley, MD; Alex Kenton, MD; Malathi Koli, MD; Vijay Koli, MD; Ashok Kumar, MD; John Lacci, medical student; David Lam, MD; W. Cannon Lewis, MD; John Menchaca, MD; Darlene Metter, MD; Jesse Moss, Jr., MD; John Nava, MD; Jennifer Nordhauser, medical student; Rajam Ramamurthy, MD; Jennifer Rushton, MD; Navid Saigal, MD; Jayesh Shah, MD; David Shulman, MD; J.
John Holcomb, MD, TMA award recipient for his over 15 years of service on the TMA Select Committee on Medicaid, CHIP and the Uninsured (center) is joined by Jayesh Shah, MD, Delegation Chair and Leah Jacobson, MD, BCMS President on May 6 during the Caucus meeting of the group.
John Holcomb, MD speaks to the TMA House of Delegates during nomination speeches on May 5.
Jennifer Rushton, MD speaks to the TMA House of Delegates during nomination speeches on May 5.
Marvin Smith, III, MD; Bernard Swift, Jr., DO; Lloyd Van Winkle, MD; and David Webster, MD. Stay tuned to this column for updates on the final results of the 2017 business of the TMA House of Delegates. For more information on how you can become a member of the BCMS Delegation to TMA, contact Mary Nava at mary.nava@bcms.org. visit us at www.bcms.org
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BCMS ALLIANCE
Get to Know Your BCMS Alliance Lori Boies, 2017 BCMS Alliance President I am always surprised when meeting new friends either in medicine or married to medicine who have never heard of the Alliance. After hearing about us, most are excited to learn more. Who wouldn’t want to be a part of a dynamic group of like-minded physician spouses and physicians? So, what is the Bexar County Medical Society Alliance (BCMSA)? We are a group of physician spouses and physicians who not only come together for social activities, but also have been giving back to our community in a variety of ways for 100 years. In 2017 alone, we have provided 600 FREE bicycle helmets to the children of San Antonio through TMA’s Hard Hats for Little Heads Program, raised $2,600 for Project Brave in honor of the life of Dr. Casey Mitchell Drawert for our Doctors’ Day Campaign, and were awarded a TMA Foundation grant to raise awareness for, as well as provide, HPV vaccinations to San Antonio locals in conjunction with Metro Health. And this is just a start of our efforts to be the face of the Family of Medicine in our community. In addition to our civic and philanthropic work, we also like to have fun! We have a variety of social events planned on our calendar
12 San Antonio Medicine • June 2017
that include our monthly Alliance Dinner Club (we meet the last Tuesday of each month at local restaurants like Rebelle, Zinc, Signature, etc.), a monthly book club, Bunco, Sips and Dips, Happy Hours, Lunch Bunch, Painting with a Twist, playdates, and more. We truly try to provide interesting and engaging activities, no matter what stage of life or interests you have! The BCMSA is your Alliance! Whether you are interested in community service, networking or finding new friends who understand the medical journey, we hope that you join us! I would like to invite you (and any physician or physician spouse friends!) to meet us on Friday, July 14, at Myron’s Steakhouse for a Networking Happy Hour. The event is from 6 – 9 in the evening; feel free to drop in at any time or maybe even stay for dinner. It’s a great opportunity to meet some of our current BCMSA members and make new friends! All spouses are welcome, of course. Bring a few extra business cards if you are interested in networking. We would love to have you! Please RSVP attendance to: rsvpBCMSA@gmail.com I look forward to seeing you soon!
GENERATIONAL PERSPECTIVES
EDITOR’S NOTE: This is the second installment in San Antonio Medicine featuring articles by local doctors or medical students who come from families with multiple generations of physicians. The stories look at both the knowledge and experiences passed down from prior generations and the influence that has been passed on to subsequent generations. If you would like to submit an article about your family please send it to Mike.Thomas@bcms.org and it may be published in future issues of the magazine.
OUR LITTLE MEDICAL FAMILY By Jaime Pankowsky, MD We were three physicians in a small family of four. I said were, because our son Dan, of blessed memory, was a Hemato-Pathologist in Nashville, but he is no more. I cannot speculate how my small family ended up being a medical family. Our daughter Helen, a San Antonio Psychiatrist, will give her own explanation in a separate article. As for, me, I was born and raised in Mexico. No member of my family recent or distant was or had been a physician. My parents had migrated to Mexico after World War I, trying to escape the poor economic conditions and the increase in virulent antisemitism in both Poland and Germany. I studied in Mexico and I liked school. I had little interest in medicine throughout elementary school, although animals and living beings interested me, but my true love was history. Among the history books I read one called “Microbe Hunters” fascinated me. Great admiration for Louis Pasteur, Robert Koch, Paul Ehrlich and others was aroused in me by the book, and I felt I would like to join the fight against those evil microbes. Needless to say, in the decades of the1930’s, penicillin, antibiotics and all the advances we now enjoy were beyond the horizon. Medical resources were also limited in Mexico, because at the time the country was just beginning to recover from 10 years of revolution and bloodshed. Entering high school, I devoted my energies to biological sciences, and shunned mathematics (big mistake). From then on, going to medical school was my goal. I entered the Preparatory School in Mexico City taking pre-medical courses and finally was admitted to the Medical School.This was at the end of World War II. My parents’ families had been devastated by the Nazis and I was distracted, in my youthful idealism, from my studies to work for the survivors in Europe and the creation of the State of Israel.
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My grades went down during my first and s e c o n d years and this would eventually make it difficult for me to obtain a residency in the United States after graduation. I was finally accepted for residency in Baltimore. By then I was already married and it was there that my two children were born. They grew up in Baltimore, Mexico, Houston, Temple and San Antonio. My desire for them was to get an education so they would not depend on anybody but themselves for their sustenance and survival. I do not recall encouraging them to be physicians, although at one time or another they asked to be allowed to watch operations while I was in the Operating Room. What their thoughts were was not known to me. I know that neither one of them wanted to be a physician initially. In college, they began taking courses unrelated to medicine. What prompted them to change is still only known to them. However, I think they both chose well and I am happy for it.
GENERATIONAL PERSPECTIVES
FAMILIAL DOCTORING By Helen Pankowsky, MD It is not unusual to see that children follow in their parents’ profession. We see it with actors, tradesm e n , politicians, and doctors. Children are, after all, exposed to the workings of the family vocation on a routine basis. This did not apply to me. I am the daughter of a surgeon, yet I never wanted to be a doctor. Even though our daily dinnertime conversation may have included an explanation of a jejunal jejunostomy or discussion of some pathophysiology or scientific topic, I was more interested in the arts — acting, painting, music, anything that was the arts was my passion. In college, I majored in art and later added psychology, moving away from fine or commercial arts towards art therapy. Close to completing the psychology courses needed for graduation, I realized that knowing the psyche alone was not enough, that I wanted to know the entire human being and I decided to go to medical school. It seemed strange to anyone who knew me that I would make this choice. I had never studied the sciences, having fulfilled my requirements by taking an astronomy course and a geology course; the two things I did love the most in science — stars and rocks. But I was convinced that not only did I want to be a doctor but I needed to be a doctor. So, armed with my two previous science courses, I set out to fulfill the pre-med requirements. I was so committed to this that I completed the pre-med requirements in a year and half, barely an adequate foundation for medical school. I was fortunate that The University of Texas Health Science Center at San Antonio at that time was interested in accepting a few medical student applicants who had a rich background in the humanities
and life experiences, of which I had both. My first year in medical school was a struggle. As I continued to build on my rudimentary knowledge of biology, chemistry, and physiology, my classmates, who for the most part had wanted to be doctors all their lives and studied the sciences, appeared to be effortlessly soaring through. It was like trying to learn advanced mathematics just barley having learned to add and subtract. At times, I doubted my decision. Even an operation that my father invited me to scrub in on is memorable for hearing my father’s voice very calmly saying shortly after the first incision, “someone please catch my daughter” before I passed out. Convinced this was yet another sign of my incapability of being a doctor, I nonetheless continued. When it seemed that I would fail anatomy, I turned to my father. As embarrassing as it was, I asked for help. His patience and extraordinary ability to teach helped me to comprehend, learn, and do better in my classes. This was our first true bonding over medicine. Over the next two years, almost nightly we worked steadily together until I got my bearings and began to feel comfortable navigating through classes in anatomy, physiology, and pathophysiology, learning what I needed in order to take on the mantle of “doctor.” Once I reached the clinical years I found myself enjoying what I had learned as I applied it. Never again did I faint in surgery and even considered it as my specialty; this in spite of the fact that when I told my resident this, he responded with “women could not be surgeons.” Although I did not agree, I did not choose surgery. Having been raised in a surgeon’s home, witnessing the ir-
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regular hours and early risings, I decided this would not be satisfying to me. Ultimately, I returned to my roots by choosing psychiatry. I now knew and understood the person as a whole organism and the abstract/philosophical nature of psychotherapy, combined with a sense that the mind was as yet an uncharted frontier to be discovered, appealed to me the most.
I have often wondered what made me decide to be a doctor. My late brother also chose medicine. Just as my passion was in art and humanities, his was in research and engineering. I chose psychiatry, he chose hematopathology, doing research and patenting prototypes for diagnostic tests that may have been very important in medicine. I don't think either of us was ever certain why we became doctors. For me, was it because I had been raised in that environment and felt comfortable in it? Was it because it was a common language that I shared with my father? Was it simply inevitable? (My son once said he felt “doomed” to be a doctor because everyone in the family was. He was reassured he was not, and became an educator instead). In retrospect being a doctor seemed so contradictory to my per16 San Antonio Medicine • June 2017
sonality. It was a challenge, but has allowed me to bring a solid foundation to the work I now do with passion — applying alternative, complementary, and holistic medical models to psychiatry, creating a niche that truly embraces all aspects of my character. So what is it that children see and learn from their parents that makes them want to be in the same profession? In acting, it may be the glamour of the stage, in business, it might be the financial rewards, in politics, the wish to influence the public sector. But for doctors, I think what we as children see the most is a profession which, regardless of specialty, is ultimately and deeply rooted in compassion for the suffering and pain of people and the desire to ease that suffering though healing. Compassion is not unique to medicine, in fact, can be applied to any profession, but it is what underlies medicine and drives the doctor to be committed to healing the mind and body. Serving in this capacity is what binds my father, my brother, myself and perhaps all physicians. This is what I learned from my father and this is what I hope my child has learned from me. Helen Pankowsky, MD is in private practice and may be reached at 210-451-1234 or email at helenpankowsky@gmail.com. Website is www.helenpankowskymd.com.
GENERATIONAL PERSPECTIVES
Living first generation medical family members in mid 2000s: Standing: (Aunt) Betty Levitt, RN, (Uncle) Herbert P. Brown, MD, (Aunt) Sylvia Brown, RN. Seated: (Mom) Joan J. Ratner, PhD, (Dad) Irving A. Ratner, MD
Multigenerational Medicine: HERB AND SYLVIA BROWN AND THEIR EXTENDED FAMILY By Herbert P. Brown, MD (retired BCMS member) My parents immigrated to Boston during the 1920’s with a minimum of education. They realized the need for education, learning English as work allowed. They also knew the importance of education for me and encouraged good grades with the hope of college and whatever studies or career beyond. As a result, I was the first in my family to go to college and the first to go to medical school (with a lot of help from my folks and my meager savings, summer jobs and scholarships, of course). So where does a college almost-graduate who knows something about electronics, neckties manufacture, and optical (eyeglass and
frames jobbing go to help him/her make the next step? I did know that I liked to fix things and help people. I went to the Jewish Counseling Service in Boston (there is one here in San Antonio too) which is open to young people of all faiths) for help in finding my inner strengths to pursue (and which financial resources that could help along the way. At the end of the counseling session I was told I would do well in a number of professional areas, but it was unlikely that I would make it into medical school. Dejected but determined I studied every spare hour (there was no Kaplan course in those days that continued on page 18
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GENERATIONAL PERSPECTIVES continued from page 17
might have helped with the MCAT). So much for counseling as to what I couldn’t do. Nevertheless, I made it and have had a fulfilling career in Obstetrics and Gynecology (43 years in total). During my career, I had a private practice in Everett. MA for 3 years, served in the navy at Jacksonville, FL for 2 years, was part of a private practice in New Brunswick, NJ for 3 years, before being enticed to come to San Antonio to practice privately OB/GYN for 21 years. Subsequently, I joined the faculty at UTHSCSA in the department of OB/GYN. In addition to the standard practice of OB/GYN, I served as Medical Director of the local affiliate of Planned Parenthood. For 26 years. Finally, I served for two years as Chief of Family Health Services for the San Antonio Metropolitan Health District. Following retirement in 2000, I serve as an Instructor of opera appreciation at the Academy of Learning in Retirement here in San Antonio.
Sylvia Brown, RN My father, Louis Ratner, was born in Derechin, Poland/Russia in 1893. This was a very small village, but he did have the opportunity to attend the Gymnasium. He never finished his education, but I think he went as far as would be a freshman in college in the U.S. He escaped to the U.S. in the 1920’s to avoid being drafted into the Russian army (a death sentence in those days) and settled in Boston, where he met and married my mother, Florence Yusefovitch. My brother, Irving Ratner and I grew up in Boston, Mass. attending the public schools. All throughout our childhood my father expressed the importance of education. He had said if the opportunity had been there he would have liked to be a physician. He also said having a background in science would always provide opportunities in life. While in high school I was always interested in biology and after taking tests at the Jewish Vocational Agency in Boston it was determined that that would be a good route to pursue. I attended Boston University getting a bachelor’s degree in biology in 1957. Subsequently, my first job was at the Boston Dispensary, a Tufts Medical affiliate, where I worked for a biochemist for one year. The next year I was employed by the Massachusetts Department of Public Health, Virus Section where I worked for 10 years. Here we did research and diagnostic tests on polio and influenza viruses. My sister-in-law, Joan Ratner, also worked there before moving to San Antonio. While at Boston University, I met 18 San Antonio Medicine • June 2017
my future husband Herb Brown who then attended Tufts University School of Medicine becoming a physician. In 1972, we came to visit my brother, Irving Ratner, and his family for two weeks and they were pied pipers encouraging us to move to San Antonio and in that two weeks Herb rented an office to practice OB/GYN and we purchased a home. After moving here, I decided to change careers and leave the laboratory and study nursing, graduating UTHSC School of Nursing in 1976. I became a pediatric oncology nurse at Christus Santa Rosa Children’s Hospital and retired from there in 2000. We were very proud when our older son, Marc, also became a physician, and his brother, Josh said there were enough physicians in the family and he went into business.
Marc Brown, MD (Dallas County Medical Society member) Having been raised by a father and uncle who were both in private medical practice, and a mother, two aunts, and cousins in various health care disciplines, the appeal of a medical career was immediately evident; there was daily evidence of both intellectual engagement and the ability to positively affect peoples’ lives. Given my interests in both science (summer research programs, visits to relatives’ offices) and finance, I was drawn to becoming a private physician as a means to directly impact patients, and yet manage my own affairs in so doing: employer rather than employee. I thus was thrilled to be offered admission to a combined 6-year medical education program (undergrad plus medical school) at the University of Michigan directly from high school in San Antonio. After medical school came a residency in anesthesiology at UT Southwestern Medical Center in Dallas, and a research fellowship in transplant anesthesia. My first position was at Cedars-Sinai Medical Center in Los Angeles, as head of transplant anesthesiology. The lure of Texas proved too strong, however, and I returned to Dallas to found a private group of anesthesiologists, Metro Anesthesia Consultants. I have helped manage and lead this group over the succeeding 25 years, and it has grown to now include 87 physicians (including 8 hospital contracts around DFW), as well as a Management Services Organization for others. I’ve served as Chief of Staff, and on Governing Boards of two hospitals, following the examples set by my father and uncle of the importance of physician citizenship. I particularly relish my continued interaction with my relatives around Texas, both on medical issues and otherwise.
GENERATIONAL PERSPECTIVES
HOW TO GET YOUR KIDS
TO BE DOCTORS By Ravi Ganeshappa, MD So how do you get your child to become a doctor? And how do you get all three of your children to be doctors? The answer is quite simple. Do nothing. It almost seems counterintuitive, however, that is exactly how my two sisters and I all went into medicine. Dad was pretty sneaky. He didn’t say a word. There was no push that you should become a doctor. There was no touting of the benefits of going into medicine. Rather, there was an intentional silence. Dad enjoyed being a doctor. He enjoyed helping people. On occasion, I would go with him to the hospital when I was younger. Mostly I hung out in the doctor’s lounge and enjoyed the free snacks. Other times, I would go with him on the ward or to the GI lab. You could see his patients and the staff were all happy to see him. They 20 San Antonio Medicine • June 2017
always had good things to say about him. He may have worked long hours, nevertheless, it all seemed worth it. The key is you must enjoy what you do. We lead by example. You don’t have to tell someone something when they can simply see it for their own eyes. I saw a similar phenomenon during residency. As an Internal Medicine intern at a busy county hospital at Parkland in Dallas, at times I was absolutely miserable. You go into survival mode. You are not always a very pleasant person in such a situation. Naturally, very few of the medical students I worked with chose to go into Internal Medicine. During my second and third years, I was much happier. I enjoyed my training. I enjoyed teaching the interns and students… and sometimes the faculty ☺ In turn, many more of our medical students chose to go into Internal Medicine. It was then that I understood his ways. And I would like to think I have adopted them. Although there are differences in generations,
GENERATIONAL PERSPECTIVES
some salient points continue — work hard, be nice, and enjoy what you do. These are keys to a successful practice. I believe my generation has shifted the pendulum to where we don’t work as hard and spend more time with friends and family. But I would like to think that this is not such a bad thing. I still wake up at 4 or 5 in the morning, and with various administrative meetings, I often don’t get home until 7 or 8 in the evening. I have adapted by taking more days off during the week. I see this as something our newer generation is doing. We are finding creative ways to have a balance between work and family. When we moved to San Antonio in 1983, Dad started a solo Gastroenterology practice. That worked well for his generation, however, the solo practice is becoming more scarce in medicine. After numerous additions of doctors and mergers of groups, we are now 116 Gastroenterologists/Hepatologists under one tax ID. Texas Digestive Disease Consultants is now the largest GI group in the country. I am proud to serve on the Executive Board for our group. Coming together as one has been the absolute best thing to happen to our practice. This is a significant change in medicine as I believe we will see more doctors coming together to form larger groups. Although this may scare the older generation, this is the future of medicine. You lose a little of bit of control, however, you gain so much more. We can do countless additional things now that we could not have done as a smaller group of 9 physicians. So will my kids go into medicine? I doubt it. My daughter Shaili wants to make a lot of money so that she can donate it all to cats. My son initially wanted to play professional basketball and then become a sports announcer. I had to burst his bubble by letting him know there are very few Indians under seven feet tall who make it to the NBA. I wanted to be an oceanographer as a child. In high school I came to the realization I can’t make much of a living looking at fish. I believe our kids will follow a different path and will decide to follow my wife’s footsteps. My wife Joana Gutierrez Ganeshappa, DDS has a much nicer lifestyle with many of the similar qualities that draw us to medicine. She is able to help people be healthier, make them feel better when they are in pain, and she is able to do a variety of procedures. It is hard to compete with this. I think Joana is still mad at me for pushing her into dentistry. She was accepted to both medical and dental school, however, I would like to believe she is happy now with her decision. She has a great solo practice where she can practice the kind of dentistry that she wants. She is able
to deliver very personalized care. And she will be leaving the kids with a fantastic practice to take over. My sister Anju is a Urologist in Salem, Oregon. My other sister Kanch is a Pediatric Anesthesiologist in New Castle, New Hampshire. They both came over to spend the weekend with us in San Antonio recently. We didn’t talk a lot about work. We primarily just had a good time and talked about our kids and life in general. We never spoke about what our kids will do with their lives. I think we will end up doing just as Dad did. Not really say anything. Lead by example. And let our kids decide what is best for them. This worked quite well for our generation. We will see how it works for the next. visit us at www.bcms.org
21
GENERATIONAL PERSPECTIVES
JOSE DIAZ, MD
JOSEPH DIAZ, MD
JOSEPH DIAZ JR, MD
A Father’s I N F LU E N C E By Joseph D. Diaz, MD
In his last semester as a senior at Antonian High School, Dr.
spected member of the San Antonio medical community that Diaz
Joseph D. Diaz found himself faced with a dilemma about his fu-
was able to have such great success in his beginning years. His fa-
ture. Looking around, he felt that every student knew exactly
ther was also a great mentor in teaching both his sister, Dr. Deb-
where they wanted to go and what they wanted to do. He did not.
orah Diaz Murphy and himself the business of medicine with these
At that time, he was already exposed to the medical field by his
four lessons at the core: be fair, be generous, know your limits and
father’s family practice on the south side of San Antonio and
ask for help.
through his sister Deborah’s experience as a sophomore in the St.
However, the influence from his father that he values most is his
Mary’s University’s pre-dentistry program. Taking a closer look at
desire to bring quality care to the socioeconomic underserved com-
the root of his dilemma was the awareness that he was questioning
munity of the South Side of San Antonio. After 29 years of prac-
his ability to succeed. Once he made the decision to venture down
tice, Allergy SA is the only clinic treating asthma, allergy and
the path of medicine, he became obsessed to the point that he
immunology conditions in the community that played such a large
earned his B.S. in biology from St. Mary’s University in three years
role in Diaz’s upbringing.
with highest honors, allowing him the privilege to attend the University of Texas Medical Branch at Galveston.
In the second half of his career, Diaz is fortunate enough to take a stronger mentorship role for the next generation of medical pro-
His father, Jose Diaz, had a tremendous influence on his career
fessionals in San Antonio. Not only is he able to mentor future
and that became most apparent as the opportunity presented itself
physicians through a partnership with St. Mary’s University, but
to start his own practice. It was through his father’s legacy as a re-
he is also able to pass down the lessons he has learned from both
22 San Antonio Medicine • June 2017
GENERATIONAL PERSPECTIVES
his father’s and his own experiences to his children.
About Joseph D. Diaz, MD: San Antonio-born, Dr. Joseph D.
As a father of seven and grandfather of one (soon to be three),
Diaz earned his B.S. in Biology from St. Mary’s University and his
Diaz takes pride in seeing his own children grow into their pro-
medical degree from the University of Texas Medical Branch at
fessions. Two of those are taking a similar path into medicine. His
Galveston. His internship and residency, as well as his fellowship
daughter Alisha is currently studying to become a physician’s as-
in Allergy and Immunology, was completed at the University of
sistant in New Mexico and his son Joseph is a current internal
South Florida College of Medicine.
medicine resident at the University of California in San Diego.
Since opening his private practice in 1988, Dr. Diaz has served
In our ever evolving field, there is one thing that Diaz hopes
on multiple medical committees and boards. He is past president
does not alter for our future medical professionals, the rewarding
of the Mexican American Hispanic Physicians Association, San
and gratifying relationships we make with our patients. He ex-
Antonio Allergy Society, and the Texas Allergy, Asthma and Im-
plains that as an allergist, he is able to foster close relationships
munology Society. He has served as Director of the A/I division
with young patients and watch as they grow and excel in their lives.
at UTHealth and as training program director. He is currently on
It is this human element of celebrating the successes of our patients
the board of the AAAAI Foundation. He directs a free Asthma
and persevering through the trying times that his father engraved
clinic in San Antonio and received the distinguished Alumni
in him and his wish for his son and daughter as they experience
Award from St. Mary’s University in 2015.
their journey into medicine. It is about improving the overall health and well-being of the individuals that make up the com-
Practice: Allergy SA | Allergy, Asthma and Immunology Associates of South Texas
munity that we are a part of.
visit us at www.bcms.org
23
GENERATIONAL PERSPECTIVES
GROWING UP IN THE
MEDICINE LIFESTYLE By Prashanth Rao, MD Medicine was a profession my parents chose to make a better life for themselves and their family. Both my parents are from large, middle-class families in South India, that were rich in culture, not so much in coin. After completing their medical residencies in the U.S., my parents moved us to Texas to start their professional careers. In the 1980s, medicine was more of a lifestyle than just a job. Relatively high reimbursements and minimal insurance regulation at the time allowed physicians the independence to craft their own private practices as they wanted, and proved to be a sort of a 'golden era' for hard working physicians. Doctors enjoyed commanding roles in their hospitals and society, and their practices were a constant part of their lives. My mother was an anesthesiologist that worked full time and still managed to shuttle my two sisters and I to piano, tennis, and dance lessons after school, and somehow have the energy to attend or host dinner parties almost every weekend. In retrospect, she had to wear too many hats which I'm sure was quite stressful. She is now fully retired from medical practice, and much more relaxed as a grandma and social butterfly/travel planner for herself and my dad. 24 San Antonio Medicine • June 2017
As a private practice ObGyn, now semi-retired, I remember my dad was always on call. He constantly had his pager on him, and was an early adopter of those large, heavy brick-like 'mobile' phones of the 1980s, lugging it about when it was still a novelty. He would show up late to dinner parties and would have to leave movie theaters halfway through the movie, to attend to calls. Despite their exhausting schedules, I never heard my parents complain about their work demands. They were always regaling us with tales of interesting medical drama and the life lessons they encountered with their colleagues and patients. The challenging diagnosis of a critical postop complication, or a surgeon’s quick thinking to avert disaster — our family meal discussions were often like morning report in residency. During these exchanges, my sisters and I would sometimes get an impression of my parents’ anticipation of the day when we would be more actively contributing, knowledgeable participants in these medical discussions. As a result of my dad's "medicine lifestyle," I did not get to spend too much social or free time with him growing up, but did get to experience life in the hospital and clinic setting from an
GENERATIONAL PERSPECTIVES
early age. I saw my first C-section when I was about 12 years old (commemorated by a brief syncopal episode), and gradually became very familiar with the sights and sounds of various healthcare settings. For summers in high school, I worked as an O.R. scrub tech, cleaning and learning how to setup operating rooms, helping sterilize instruments, and occasionally holding a limb or retractors in a particular position during a procedure. I found medicine interesting, but all this exposure to it still did not quite convince me that it was the right profession for me — a feeling that lasted through my college years in Austin. Both of my sisters were very motivated students, and seem to have more readily absorbed my parent’s medical aspirations for us into their own. They predictably progressed from high school to college, to medical schools, to residencies and fellowships. Apparently, I was a slightly harder nut to crack. Despite all the same medicine exposure growing up (there are pictures of my sister and I dressed in full surgical garb for Halloween, when we were 11 years old), it wasn't until after college, when I was volunteering at a WHO sponsored polio-vaccination & preventative health effort in India, and personally witnessed the vast numbers of people who desperately needed quality medical care, and I saw firsthand how much of a difference dedicated physicians could make — that's when my interest in medicine was piqued, and when I seriously began considering it as a profession. Unlike my parents who had very little growing up, I had everything a child could ask for. My circumstances and perspective were different from theirs in that I wasn't driven to look for professional opportunities to better my socioeconomic situation, which thanks to my parents, had always been quite comfortable. Even though I had spent a good amount of time exposed to hospitals and clinics in the U.S., it took participation in an often chaotic public health effort in dusty streets on the other side of the world, to reveal to me a previously unknown kind of personal satisfaction that came with working hard in the service of others health needs. This contentment and the associated intrinsic happiness it kindled in me, is primarily what drove me to become a physician. Now as an employed internist in a hospital-based practice in San Antonio, I have a reasonably good work-life balance. I am not perpetually on call, don't spend much time on administrative or financial issues, and work in the hospital every other week. The demands and complexities of hospitalized patients can be exhausting, and the time off helps us recharge and be more empathic caregivers when we're back at the hospital. One of my sisters became a radiologist and is employed with a large hospital system in Houston, and the other became an ophthalmologist and is employed with one of the largest retinal specialist groups in Chicago. These are different models of medical practice then my parents
knew. Medicine has evolved into more of a team sport, with physicians now being just another member of an ever-expanding team. Increasing expenses, frequently burdensome insurance reimbursement requirements and progressively stringent quality metrics are forcing physicians to abandon their private practices and turn towards employment with large hospital systems or companies. Many of the requirements of modern-day medicine are forcing the physician to, bit-by-bit, spend more time in front of a computer screen than with patients. In spite of all this, I usually walk out of the hospital still feeling that sense of fulfillment in service to those in need. As long as I feel that, I will continue to practice medicine. However, will my wife and I encourage our children to be third generation physicians? At this time, I just don't know. There will always be a need for healthcare and physicians, but I want our children to be happy and satisfied in their careers. At the rate that medicine is changing, the role of physicians in the next few decades is yet undefined. Clinic based physicians will have increasing regulations and restrictions by insurance companies on diagnostic tests and therapeutic interventions. To meet increasing hospital demands, telemedicine doctors or even medical robots may be increasingly used to triage patients in the emergency department and round on them in the hospital, and even performing routine surgical procedures. All this in the context of the intensifying needs of an aging, severely chronically ill, and often litigious patient population who are in an already resourcestrained and cash strapped health system. In these circumstances, would physicians still be able to deliver the standard-of-care, evidence based interventions we were trained to do, or will they become more data analyst/resource conservators, continuously having to compromise medical decisions for the sake of what corporate employers or insurance companies will authorize? The innumerable variables make predicting the future of healthcare very difficult. I think most of us tend to hope for the best, but prepare for the worst. As Charles Darwin himself noticed 150 years ago, a key characteristic to the survival of an organism is constant striving. I don't dress my kids up in doctor outfits, and our family meals are not like signout rounds at work. My wife and I simply try to encourage our children to find a job which creates that same feeling of deep-seated happiness that I stumbled upon while doing simple rural public health service those many years ago. As long as our children work hard at what they love to do, I think that whichever professional path provides them that strong sense of personal satisfaction, their raison d'etre - that would be the one we would encourage them towards. If it turns out to be medicine, great. If not, great. visit us at www.bcms.org
25
FEATURE: IN REAL TIME
Part 6
IN REAL TIME For better, for worse, for richer, for poorer, in sickness and in health By Rajam Ramamurthy, MD
Home is the best place for a patient like N who was under gigantic mental turmoil and stress. Familiarity of the environment helps. Establishing a routine should be a priority. This is easier said than done. In N’s case the stars configured positively. He has a home, I am retired and could be with him twenty-four-seven. We have long term Insurance that covered caregiver assistance. I met with people from three different agencies and chose one that was a good fit for us. We set up a room that was comfortable for N and convenient for the caregiver to stay and rest if possible when N slept. N did not 26 San Antonio Medicine • June 2017
sleep much; the little sleep was disrupted by coughing. The intubation must have set up some inflammation of his airways; he was constantly taking cough lozenges, a pack or more a day, no one could control him. Caregivers were men and women and because of work hour regulations in a week at least six different people came. It was unnerving for me to have different strange men in the house every night. N was least sensitive to my feelings or my needs. N protested not sleeping in his bed the first night. On the second day he did not protest and the caregiver told me that he said to her that I won’t like
FEATURE: IN REAL TIME
strangers in the room when I am sleeping. At some deep level N had some understanding and he would cooperate, like taking his medicines. For a 48-hour period I had to go out of town for a wedding and the caregivers cared for N very well. The caregivers from an agency called Visiting Angels were indeed angels. N demanded attention continuously. The care givers seemed to know exactly how to handle him. I took the caregivers with me for all his appointments, 2-4 a week. I was not prepared to send him with them. I would break myself from home and go to the office, keep up with some meetings or run an errand. This was my strategy for refreshing me and having the energy to manage a million things. On Fridays, I went to teach dance to children which was my moment of meditation. On Fridays we did not have a caregiver, our friends wanted to spend time with N. One started teaching him to play bridge, one would watch tennis on TV with him, and one took him out to eat. These acts of kindness played a major role in his healing and mine as well. Physical therapy was scheduled three times a week for his shoulder. N knows every nerve and muscle in the human body and taught the therapist a few things. He could not lift his arm more than 30 degrees. Heat pads and pain medication helped. The therapists were wonderful. Under the guidance of Dr. Mehta, Justin, the therapist who worked with N, was very efficient, kind and thoughtful. When N’s diagnosis was made, my mode was to prepare for our lives for the years to come. Downsizing from this huge home and vast acreage weighed on me heavily. In our home I was the indoor person. The furniture, décor, meals, social calendar, keeping up with the extended family, gifts were in my portfolio. Outdoors, appliances and finance were N’s portfolio. Early in January, without my knowledge N had ordered new computers. I had to get a technician to help switch the computers. N told the technician that all the data was backed up which was not the case and we lost all the old data. I had no idea about the well, pump, rain water storage and a zillion other outdoor things. My gut feeling was to just run from the place. I thought that we should look at assisted living facilities. This was an education in itself. My introduction to an assisted living facility came as a phone call from one of them. The long-term insurers, the caregiver organizations, assisted living facilities all seem to have some network. The assisted living facilities that they are building these days have independent living homes in the same complex. You cannot buy them, you rent. They do not provide any assistance, you will have to hire assistance depending on the need. To stay in an assisted living apart-
ment one must qualify. If a couple has to stay together they must both qualify, in other words you must have a doctors certificate indicating the need for assistance. In these the resident will be provided with three meals a day and will be taken to different activities, medical appointments and some outings. The resident can freely go in and out of the apartment. They also have something called memory care units. These are similar to assisted living except the resident cannot wander away beyond a certain area. The residents in both live by themselves. There is no cooking facility in these units. The independent homes appealed to me in case we need the assisted living so the transition would be seamless. The facility we chose was under construction. N’s Psychiatrist is a wizard. I was with N for almost all his appointments. Dr. Schillerstrom always managed to convince N to make changes in his medications or to take some that N categorically refused to take because of the side effects. He was also not keen on loading multiple medications. N was placed on two medicines, one to help with sleep and the other an anticonvulsant which is also a mood stabilizer. I was determined to make life as normal as possible for us. I took N with me everywhere I went; grocery shopping, lectures at the health science center, shows and restaurants. I avoided big gatherings at people’s homes, weddings; temple and other events where too much interaction was needed. Not being cooped up in the house was very good for me as a caregiver. When I met close friends I shared N’s condition with them. We had a steady stream of relatives who visited us. This was good for N. In the midst of this I had to undergo cataract surgery as night driving was becoming difficult. In May 2016, I had the right eye operation and our son was with us. N came to the pre-op area and talked to the anesthesiologist explaining how sensitive I am to any sedative. It gave me a glimmer of hope. On June 17, 2016, N said to me “I am sorry, I have not brought flowers for you as I cannot drive to HEB.” It was my birthday. Through my tears I saw the immense sorrow on his face and I knew my N was struggling to emerge from a deep ocean where fate had drowned him. Rajam Ramamurthy. MD Professor Emeritus, Department of Pediatrics UTHSCSA
visit us at www.bcms.org
27
LEGAL EASE
Naked in Vegas. Now What? By George F. “Rick” Evans, Jr., General Counsel BCMS, Evans, Rowe & Hollbrook
You made it to Vegas for that fun-filled weekend but your luggage didn’t. What do you do? This is the third in a series of articles on the woes of air travelers and their legal rights. Today we talk about when you’re at your destination but your bags aren’t. And, by that, I mean more than just lost luggage, but luggage that isn’t really lost but just delayed. This isn’t an uncommon scenario. In 2012, there were 1.78 million reports filed by passengers over delayed or lost bags. Here’s what may expedite your reunion with them. Immediately go to the baggage agent for your airline (usually near the carousel) and report the absence of your bags. If you’ve followed tip No. 2, below, show them the pics. Don’t leave the airport and call the loss in later unless you absolutely have to. There are deadlines you must comply with, ranging from 7 to 21 days. Now, this is where it’s important to know your rights. The law for domestic flights allows you to demand compensation for up to $3,500. Don’t let the agent tell you the contrary and try to brush you off with a toothbrush and paste for the night. If they do, cite to them 14 Code of Federal Regulations Section 254.4. Trust me. They know it. The specific amount you get depends on the circumstances. If, for example, you’re wearing a polo shirt and shorts and have a crucial business meeting that afternoon, you’re entitled to be paid for the continued on page 30
28 San Antonio Medicine • June 2017
reasonable costs of a suit, shirt, tie, shoes, etc. Conversely, if you’re just going to the roulette table, you may not get anything besides some pajamas if they can find the bag and get it to you by tomorrow morning. Of course, at the time this is happening to you, nobody knows if your baggage is delayed or permanently lost. And, even if it’s just delayed, nobody knows whether it’s for a few hours or a week. This means the amount of your compensation will change with each day. A delay of a few hours may mean nothing. But nobody can expect you to wear the same clothes for days on end. You’ll have to work with the agent on a reasonable allowance. Your other alternative is to just buy what you know is reasonable and present them with a claim after the fact. If the costs are fair and you can justify why you bought what you did, you should prevail. If your bags are actually lost, you’re only entitled to their depreciated value at the time of loss; not what it costs to actually replace them with new items. Used clothing isn’t worth a lot so don’t expect a lot. The airlines want receipts for your stuff but who among us has a receipt for the boxer shorts you bought 2 years ago? But, if you’ve followed Tip No. 2, below, you can show them what you packed and they have to pay you for the value of the things you can prove they lost.
LEGAL EASE continued from page 28
To avoid this mess in the first place, or to bolster your rights if it happens, here are some very useful tips. 1.
Consider putting a GPS tracking device in your bags. Google it and you’ll find many for sale. The airlines have sophisticated tracking devices but this assures they can’t bamboozle you or give you bad information.
2. Take pictures of your bag and contents on your cell phone. It will be useful to help the airline locate it and, if they can’t, it will provide strong support for your claim for reimbursement. 3. Make sure you get to the airport with enough time to get your bags checked at least 45 minutes before departure. If you don’t, you’re in for a battle if your bags are delayed (although they’re still fully responsible if they’re lost). 4. Never, ever put anything indispensable in your checked bags, like medicine, passports, tickets, etc. And never pack cash, jewelry, artwork, cameras, computers, heirlooms, etc. The agent will show you their Contract of Carriage which typically excludes such things. That said, the law cited above actually supercedes their contract so their exclusions are generally regarded as invalid by lawyers. You are allowed to get the value of your lost camera, but you’re probably in for a long battle over it, so don’t pack it in the first place. 5. You may not want to travel with bright pink suitcases, but at least try to avoid blah black. If that’s what you’ve got, adorn it with some bright attachments to set it apart from the crowd. 6. Your contact information should be not just outside the bag, but inside, too. Leave your cell number so they’re not calling your house when you’re in Vegas. 7. Non-stop flights have a better track record than those with connections so fly that when given the option. And, not all airlines are alike. A recent DOT report showed some airlines were six times worse than others. Do your Google homework before you book your flight if you’ve got a choice among airlines. 8. Consider buying travel insurance through TravelGuard or Allianz. It will cover all sorts of stuff not the least of which is lost/delayed bags. You can also buy increased value insurance from your airline at the time you check your bags in. 30 San Antonio Medicine • June 2017
9. Don’t forget to request a refund of any extra payments you may have made for check in baggage. It’s your right. 10. If you haven’t been paid your due, file a complaint with the Department of Transportation. You can do it online at www.tranportation.gov/airconsumer. They actually do go after airlines rather effectively and can help you. You can also bring a claim against the airline in your local small claims court if you can’t find a lawyer to write a letter for you. 11. Lastly, this is a matter of negotiation between you and the agent. The law requires reasonable compensation given your particular circumstances. That’s a lot of wiggle room. What’s reasonable may well differ depending on your perspective. So, let them know you’re aware of your rights, be firm, but also be calm and polite. You’ll catch more flies with honey than vinegar. We’ve seen a lot of press on airlines lately and it’s rather serendipitous. I prepared this series of three articles months ago, long before an unfortunate passenger was hauled off a United flight. Let’s hope my articles become quickly obsolete by the passage of new, more consumer-friendly laws for air travelers.
OPINION
DON’T GO TO A FREESTANDING ER IF YOU HAVE THE FLU;
IT COULD COST YOU $2,000 By Bernard Swift, Jr, DO, MPH/CEO, Founder of Texas Med Clinic
Editor's Note: Responses or rebuttals to opinion pieces are welcome. Send to Mike.Thomas@BCMS.org. The Rice University study “Freestanding Emergency Departments in Texas deliver costly care, sticker shock” released in March confirms what leaders in the emergency and urgent care industries have known for several years: Freestanding emergency rooms (FSER) charge 10 - 15 times more than urgent care clinics (UCCs) for treatment of similar problems. The study noted that in 2015, the total price of a FSER visit averaged $2,199 versus $168 for an UCC. The study also noted that 15 of the 20 most common diagnoses such as flu, strep throat and upper respiratory infections that are treated at FSERs were also in the top 20 treated in an UCC. In 32 San Antonio Medicine • June 2017
other words, those are simple problems for which care can be handled for less cost at an UCC. FSERs lack of transparency leads to consumer confusion when choosing the most appropriate venue for urgent health care services at a reasonable cost. This is very disconcerting for consumers and payers alike, and needs to be addressed by legislators, insurance companies, employers and consumers. As a physician and Chief Executive Officer for UCCs located throughout South Central Texas, I believe there should be transparency and accountability for all medical providers. We all provide a resource to the communities we serve. However, consumers need to be aware of the differences between urgent and emergency care and the costs associated with each.
OPINION The cost of a visit to an UCC is less than a visit to a hospital-based emergency room (HBER) or FSER for several reasons: • HBERs invest in specialty equipment and staff that can care for life-threatening illnesses or trauma and can move patients rapidly and seamlessly towards definitive care. A large facility fee is charged to all patients, regardless of the severity of the problem; • HBERs and FSERs have an “emergency” approach to all medical problems, generally resulting in extensive and costly "mega" work-ups, even for relatively simple problems. • FSERs exploit a provision in the law that allows them to charge an expensive facility fee (just like a HBER) for simple urgent type problems. To make matters worse for consumers, FSERs are not connected to or located within a full-service hospital. While their fees are just as high as those found in a HBER, they suffer from a lack of proximity to state-of-the-art definitive care services for problems like stroke, heart attack, or trauma requiring immediate surgery. All these more serious patients must be transported to a hospital with the attendant delay, thereby generating additional cost and medical risk. The presumption that care is the same at a FSER and a HBER is false and, at the very least, misleading. FSERs are more like UCCs.
While they are required to maintain much of the equipment and staffing that a HBER does, they don't have rapid and seamless availability of definitive treatments in a true emergency. Thus, a need for a cath lab, stroke center, or surgical suite always necessitates transfer to a hospital, thereby wasting precious time. And, in a true emergency, it is time that is the most critical component to receiving quality care. FSERs need to shoot straight and be transparent about the limitations on the care, and the costs of that care, thereby allowing consumers to choose what is best for their family’s health care and pocket books. While employees may not concern themselves with these higher costs if their insurance pays for a HBER or FSER visit, they should know that their employers are the ultimate payers. The high costs ultimately result in reduced salaries. All employees, patients and their families have a responsibility to themselves and their employers to understand the differences between costs and services provided at HBERs, FSERs and UCCs to ensure they receive the appropriate care for the best value. Because, I am pretty sure most do not want to pay $2,000 for the flu. Dr. Bernard Swift is the founder and managing partner of Texas MedClinic, a chain of 17 urgent care clinics located in San Antonio, New Braunfels and the Austin area.
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PUBLIC SERVICE
Who’s on First? By Kirby Turner, MD, DABPN, FACFP
ICS stands for INCIDENT COMMAND SYSTEM. It is a standardized approach to command control and coordination for emergency response to disasters. It started in Arizona in 1968. After 9/11, by presidential order, it became the system used throughout the United States for response to disasters — either man-made or natural. On March 1, 2004, the Department of Homeland Security, in accordance with the passage of Homeland Security Presidential Directive 5 (HSPD-5) calling for a standardized approach to incident management amongst all federal, state, and local agencies, developed the National Incident Management System (NIMS) which integrates ICS. Additionally, it was mandated that NIMS (and thus ICS) must be utilized to manage emergencies in order to receive federal funding. Incidents are defined within ICS as unplanned situations necessitating a response. Examples include: • Emergency medical situations (ambulance service) • Hazardous material spills • Man-made disasters such as vehicle crashes, industrial accidents, train derailments, or structure fires • Natural disasters such as wildfires, flooding, earthquakes or tornados • Public Health incidents, such as disease outbreaks • Search and Rescue operations 34 San Antonio Medicine • June 2017
• Technological crisis • Terrorist attacks Prior to ICS, when multiple agencies responded to disasters there was so much disorganization and confusion that response was ineffective AND many times this was a safety hazard in itself. If one wants to see what emergency preparedness and response was like prior to ICS look up Abbott and Costello’s sketch “entitled “Who’s on First” on YouTube. NOT understanding the ICS system is like going to a dance and not knowing how to dance, or going to a formal dinner and not understanding etiquette regarding the proper utilization of the dinner utensils. It’s like driving and NOT understanding the rules of the road. For medical practitioners who desire to volunteer their services during a disaster and do not want to appear uninformed or confused AND DO NOT WANT TO PUT THEMSELVES IN A DANGEROUS SITUATION when attending a disaster, one can take ICS courses 100, 200, 700 and 800. These are available free online and are self-paced. Website is: https://training.fema.gov/emiweb/is/icsresource/ For more information contact the Bexar County Medical Society Emergency Preparedness Committee.
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.
ACCOUNTING FIRMS RSM US LLP (HH Silver Sponsor) RSM US is one of Texas’ largest, locally owned CPA firms, providing sophisticated accounting, audit, tax and business consulting services. Vicky Martin, CPA 210-828-6281 vicky.martin@rsmus.com www.rsmus.com “Offering service more than expected — on every engagement.” Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”
ACO/IPA
IntegraNet Health (HHHH 10K Platinum Sponsor) IntegraNet Health is an Independent Physician Association that helps physicians achieve higher reimbursements from insurance companies whereby some of our higher performing physicians are able to achieve up to 200% of Medicare FFS. Executive Director Alan Preston, MHA, Sc.D. 1-832-705-5674 Apreston@IntegrNetHealth.com www.integraNetHealth.com
ASSET MANAGEMENT
Intercontinental Wealth Advisors LLC. (HHH Gold Sponsor) Your money’s worth is in the things it can do for you, things that are as unique and personal as your heart and mind. We craft customized solutions to meet in-
36 San Antonio Medicine • June 2017
vestment challenges and help achieve financial objectives. Vice President Jaime Chavez, RFC® 210-271-7947 ext. 109 jchavez@intercontl.com Wealth Manager David K. Alvarez, CFP® 210-271-7947 ext. 119 dalvarez@intercontl.com Vice President John Hennessy, ChFC® 210-271-7947 ext. 112 jhennessy@intercontl.com www.intercontl.com “Advice, Planning and Execution that goes beyond portfolio management”
ATTORNEYS
Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice. Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions”
Strasburger & Price, LLP (HHH Gold Sponsor) Strasburger counsels physician groups, individual doctors, hospitals, and other healthcare providers on a variety of concerns, including business transactions, regulatory compliance, entity formation, reimbursement, employment, estate planning, tax, and litigation. Carrie Douglas 210.250.6017 carrie.douglas@strasburger.com Cynthia Grimes 210.250.6003 cynthia.grimes@strasburger.com Marty Roos
210.250.6161 marty.roos@strasburger.com www.strasburger.com “Your Prescription for the Common & Not-So Common Legal Ailment”
BANKING
Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett 210- 343-4556 jeanne.bennett@amegybank.com Karen Leckie 210-343-4558 karen.leckie@amegybank.com www.amegybank.com “Community banking partnership”
BB&T (HHH Gold Sponsor) Checking, savings, investments, insurance — BB&T offers banking services to help you reach your financial goals and plan for a sound financial future. Stephanie Dick Vice President- Commercial Banking 210-247-2979 sdick@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com
BBVA Compass (HHH Gold Sponsor) Our healthcare financial team provides customized solutions for you, your business and employees. Commercial Relationship Manager — Zaida Saliba 210-370-6012 Zaida.Saliba@BBVACompass.com Global Wealth Management Mary Mahlie 210-370-6029 mary.mahlie@bbvacompass.com Medical Branch Manager
Vicki Watkins 210-592-5755 vicki.watkins@bbva.com Business Banking Officer Jamie Gutierrez 210-284-2815 jamie.gutierrez@bbva.com www.bbvacompass.com “Working for a better future”
Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Ken Herring 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com “We’re here for good.”
IBC Bank (HHH Gold Sponsor) IBC Bank is a $12.4 billion multibank financial company, with over 212 facilities and more than 325 ATMs serving 90 communities in Texas and Oklahoma. IBC BankSan Antonio has been serving the Alamo City community since 1986 and has a retail branch network of 30 locations throughout the area. Markham Benn 210-518-2500, ext. 26921 MarkhamBenn@ibc.com www.ibc.com “Leader in commercial lending.”
Ozona Bank (HHH Gold Sponsor) Ozona National Bank is a full-service commercial bank specializing in commercial real estate, construction (owner and non-owner occupied), business lines of credit and equipment loans. Lydia Gonzales 210-319-3501 lydiag@ozonabank.com www.ozonabank.com
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY ployees with free personalized banking services.” The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Brandi Vitier 210-807-5581 brandi.vitier@ thebankofsa.com www.thebankofsa.com
SSFCU (HHH Gold Sponsor) Founded in 1956, Security Service provides medical professionals with exceptional service and competitive rates on a line of mortgage products including one-time close construction, unimproved lot/land, jumbo, and specialized adjustable-rate mortgage loans. Commercial Services Luis Rosales 210-476-4426 lrosales@ssfcu.org Investment Services John Dallahan 210-476-4410 jdallahan@ssfcu.org Mortgage Services Glynis Miller 210-476-4833 gmiller@ssfcu.org Firstmark Credit Union (HH Silver Sponsor) Address your office needs: Upgrading your equipment or technology? Expanding your office space? We offer loans to meet your business or personal needs. Competitive rates, favorable terms and local decisions. Gregg Thorne SVP Lending 210-308-7819 greggt@firstmarkcu.org www.firstmarkcu.org Frost (HH Silver Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses. Lewis Thorne 210-220-6513 lthorne@frostbank.com www.frostbank.com “Frost@Work provides your em-
RBFCU (HH Silver Sponsor) 210-945-3800 nallen@rbfcu.org www.rbfcu.org
CONTRACTORS/BUILDERS /COMMERCIAL
Cambridge Contracting (HHH Gold Sponsor) We are a full service general contracting company that specializes in commercial finishouts and ground up construction. Rusty Hastings Rusty@cambridgesa.com 210-337-3900 www.cambridgesa.com
Huffman Developments (HHH Gold Sponsor) Premier medical and professional office condominium developer. Our model allows you to own your own office space as opposed to leasing. Steve Huffman 210-979-2500 shuffman@huffmandev.com Lauren Spalten 210-667-6988 lspalten@huffmandev.com www.huffmandev.com
FINANCIAL SERVICES
Northwestern Mutual Wealth Management (HHHH 10K Platinum Sponsor) Our mission is to help you enjoy a lifetime of financial security with greater certainty and clarity. Our outcomebased planning approach involves defining your objectives, creating a plan to maximize potential and inspiring action towards your goals. Fee-based financial plans offered at discount for BCMS members. Eric Kala CFP®, AEP®, CLU®, ChFC® Wealth Management Advisor | Estate & Business Planning Advisor 210.446.5755 eric.kala@nm.com www.erickala.com “Inspiring Action, Maximizing Potential”
Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Jeffrey Allison 210-268-1530 jallison@ aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”
e3 Wealth, LLC (HHH Gold Sponsor) Over $550 million in assets under management, e3 Wealth delivers truly customized solutions to individuals and businesses while placing heavy emphasis on risk minimization, tax diversification, proper utilization and protection for each client's unique financial purpose. Managing Partner Joseph Quartucci, ChFC® 512-268-9220 jquartucci@e3wealth.com Senior Partner Terry Taylor 512-268-9220 ttaylor@e3wealth.com Senior Partner Jennifer Taylor 512-268-9220 jtaylor@e3wealth.com www.e3wealth.com
Intercontinental Wealth Advisors LLC. (HHH Gold Sponsor) Your money’s worth is in the things it can do for you, things that are as unique and personal as your heart and mind. We craft customized solutions to meet investment challenges and help achieve financial objectives. Vice President Jaime Chavez, RFC® 210-271-7947 ext. 109 jchavez@intercontl.com Wealth Manager David K. Alvarez, CFP® 210-271-7947 ext. 119 dalvarez@intercontl.com Vice President John Hennessy, ChFC® 210-271-7947 ext. 112 jhennessy@intercontl.com www.intercontl.com
“Advice, Planning and Execution that goes beyond portfolio management” First Command Financial Services (HH Silver Sponsor) Nigel Davies 210-824-9894 njdavies@firstcommand.com www.firstcommand.com
GRADUATE PROGRAMS Trinity University (HH Silver Sponsor) The Executive Master’s Program in Healthcare Administration is ranked in the Top 10 programs nationally. A part-time, hybrid-learning program designed for physicians and healthcare managers to pursue a graduate degree while continuing to work full-time. Amer Kaissi, Ph.D. Professor and Executive Program Director 210-999-8132 amer.kaissi@trinity.edu https://new.trinity.edu/academics/departments/health-careadministration
HEALTHCARE REAL ESTATE SAN ANTONIO COMMERCIAL ADVISORS (HH Silver Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”
HOME HEALTH SERVICES Abbie Health Care Inc. (HH Silver Sponsor) Our goal at Abbie health care inc. is to promote independence, healing and comfort through quality, competent and compassionate care provided by skilled nurses, therapists, medical social worker and home health aides at home. Sr. Clinical Account Executive Gloria Duke, RN 210-273-7482 Gloria@abbiehealthcare.com "New Way of Thinking, Caring & Living"
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY continued from page 37
HOSPITALS/ HEALTHCARE SERVICES
Southwest General Hospital (HHH Gold Sponsor) Southwest General is a full-service hospital, accredited by DNV, serving San Antonio for over 30 years. Quality awards include accredited centers in: Chest Pain, Primary Stroke, Wound Care, and Bariatric Surgery. Director of Business Development Barbara Urrabazo 210.921.3521 Burrabazo@Iasishealthcare.com Community Relations Liaison Sonia Imperial 210-364-7536 www.swgeneralhospital.com “Quality healthcare with you in mind.”
Warm Springs Medical Center Thousand Oaks Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research. Central referral line 210-592-5350 “Joint Commission COE.” Methodist Healthcare System (HH Silver Sponsor) Palmire Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com Select Rehabilitation of San Antonio (HH Silver Sponsor) We provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges. Miranda Peck 210-482-3000 Jana Raschbaum 210-478-6633 JRaschbaum@selectmedical.com mipeck@selectmedical.com http://sanantonio-rehab.com “The highest degree of excellence in medical rehabilitation.”
38 San Antonio Medicine • June 2017
INSURANCE
SWBC (HHHH 10K Platinum Sponsor) SWBC is a financial services company offering a wide range of insurance, mortgage, PEO, Ad Valorem and investment services. We focus dedicated attention on our clients to ensure their lasting satisfaction and long-term relationships. VP Community Relations Deborah Gray Marino 210-525-1241 DMarino@swbc.com Wealth Advisor Gil Castillo, CRPC® 210-321-7258 Gcastillo@swbc.com Mortgage Kristie Arocha 210-255-0013 karocha@swbc.com SWBC Mortgage www.swbc.com Mortgages, investments, personal and commercial insurance, benefits, PEO, ad valorem tax services
TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need. Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free insurance portfolio review.”
Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com
INSURANCE/MEDICAL MALPRACTICE
Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and the Dallas, Harris, Tarrant and Travis county medical societies. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society
The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.” The Doctors Company (HH Silver Sponsor) The Doctors Company is fiercely committed to defending, protecting, and rewarding the practice of good medicine. With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer. Learn more at www.thedoctors.com. Susan Speed Senior Account Executive (512) 275-1874 Susan.speed@thedoctors.com Marcy Nicholson Director, Business Development (512) 275-1845 mnicholson@thedoctors.com “With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer”
MedPro Group (HH Silver Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance. Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com ProAssurance (HH Silver Sponsor) Group (rated A+ (Superior) by A.M. Best) helps you protect your important identity and navigate today’s medical environment with greater ease—that’s only fair. Keith Askew Market Manager kaskew@proassurance.com Mark Keeney Director, Sales mkeeney@proassurance.com 800.282.6242 www.proassurance.com
MEDICAL SUPPLIES AND EQUIPMENT
Henry Schein Medical (HHHH 10K Platinum Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 percent to 50 percent.”
MERCHANT CARD/CHECK PROCESSING Firstdata/Telecheck (HH Silver Sponsor) We stand at the center of the fastpaced payments ecosystem, collaborating to deliver nextgeneration technology and help our clients grow their businesses. Sandra Torres-Lynum SR. Business Consultant 25 years of dedicated service 210-387-8505 Sandra.TorresLynum@FirstData.com ‘The true leader in the payments processing industry’
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY OFFICE EQUIPMENT/ TECHNOLOGIES
www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”
SENIOR LIVING Dahill (HHH Gold Sponsor) Dahill offers comprehensive document workflow solutions to help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes. Major Account Executive Wayne Parker 210-326-8054 WParker@dahill.com Major Account Executive Bradley Shill 210-332-4911 BShill@dahill.com Add footer: www.dahill.com “Work Smarter”
PAYROLL SERVICES
SWBC (HHHH 10K Platinum Sponsor) Our clients gain a team of employment experts providing solutions in all areas of human capital – Payroll, HR, Compliance, Performance Management, Workers’ Compensation, Risk Management and Employee Benefits. Kristine Edge Sales Manager 830-980-1207 Kedge@swbc.com Working together to help our clients achieve their business objectives.
PROFESSIONAL ORGANIZATIONS
Legacy at Forest Ridge (HH Silver Sponsor) Legacy at Forest Ridge provides residents with top-tier care while maintaining their privacy and independence, in a luxurious resortquality environment. Shane Brown Executive Director 210-305-5713 hello@legacyatforestridge.com www.LegacyAtForestRidge.com “Assisted living like you’ve never seen before.”
STAFFING SERVICES
Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Brody Whitley, Branch Director 210-301-4362 bwhitley@ favoritestaffing.com www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.” To join the Circle of Friends program or for more information, call 210-301-4366 or email August.Trevino@bcms.org Visit www.bcms.org
The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, non-profit, R&D, healthcare delivery, professional services and more! President Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Program Coordinator Valerie Rogler 210-904-5404 Valerie@thehealthcell.org
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HEALTH
YOGA AS MEDICINE By Hetal Nayak, MD
The daily choices we make in life can greatly impact our current and future state of health. Yoga, in its many forms, can serve as a simple guide to help create health-based habits by encouraging individuals to take greater responsibility for their own health and by making more enlightened choices in everyday living. In 2014, the United Nations adopted June 21— Summer Solstice Day — as the ‘International Day of Yoga’ that is now adopted by 175 countries. This is the story of one physician and a lifetime shaped by yoga. When we moved to Floresville in July 2004 for my husband’s job, I had no idea that the month prior was to be the last month of my anesthesia practice. I decided to stay home with our 2-year-old for a few months. The break extended and our second daughter was born. She was diagnosed with TAPVR (Total anomalous pulmonary venous return) when she was 5-month-old and needed an urgent corrective open-heart surgery. I was diagnosed with pelvic floor prolapse at the same time. I could not walk or stand for a long time as this would cause tremendous fatigue and heaviness in the pelvic floor. Resisting vaginal hysterectomy at age 32, I felt the need to improve my core strength through other mechanisms. That was my introduction to yoga. Simple practice of yoga, besides strengthening my core, brought a tremendous change in my personality. Introduction to the text ‘Yoga Sutra’ gave a deeper understanding of the philosophy within it. Now, at age 43, and with a PhD in yoga, I feel stronger than I have ever felt. With the physical practice of yoga your body awareness changes as increased awareness brings mindfulness and mindfulness leads to 40 San Antonio Medicine • June 2017
making healthy choices in the food you eat, the TV shows you watch, the company you keep, the activities you choose and your sleeping habits. It brings about a complete transformation of your way of life. It also brings positive changes in the people around you. My husband, a cardiologist, now practices yoga regularly and recommends the same to his patients. The byproducts of this practice are that my bones on the X-ray look healthier and younger than ever. I can eat to my heart’s content and not worry about gaining weight and my HDL has doubled. My LDL has reduced to half and this year I was able to climb the mountains in Colorado, a steep hike for 1.6 miles, to 14,000 feet elevation in less than an hour. It is now my passion to pass on the knowledge of yoga to the people of this city and make San Antonio a healthy city through yogic lifestyle. In conjunction with the third annual ‘I Do Yoga Day,’ a targeted program is planned for physicians and healthcare personnel on Saturday, June 17, 2017. Titled ‘Yoga as Lifestyle Medicine,’ the session will feature Dr. Sat Bir S. Khalsa, PhD, assistant professor of medicine at Harvard Medical School, as the keynote speaker. San Antonio’s Dr. Venkat Srinivasan will also speak on a healthy lifestyle. In conclusion, according to the World Health Organization, by 2020, two-thirds of all diseases will be lifestyle-based. Chronic disease is responsible for up to 80 percent of all healthcare expenditures. Yet most health care professionals treat chronic disease the same way they treat communicable disease — with pills and injections. Let’s begin the dialogue about a healthy San Antonio.
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42 San Antonio Medicine • June 2017
RECOMMENDED AUTO DEALERS AUTO PROGRAM
• • • •
We will locate the vehicle at the best price, right down to the color and equipment. We will put you in touch with exactly the right person at the dealership to handle your transaction. We will arrange for a test drive at your home or office. We make the buying process easy! When you go to the dealership, speak only with the representative indicated by BCMS.
Ancira Chevrolet 6111 Bandera Road San Antonio, TX
Batchelor Cadillac 11001 IH 10 W at Huebner San Antonio, TX
Jude Fowler 210-681-4900
Esther Luna 210-690-0700
GUNN AUTO GROUP
GUNN AUTO GROUP
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GUNN Honda 14610 IH 10 W San Antonio, TX
GUNN Infiniti 12150 IH 10 W San Antonio, TX
GUNN Acura 11911 IH 10 W San Antonio, TX
GUNN Nissan 750 NE Loop 410 San Antonio, TX 78209
Bill Boyd 210-859-2719
Pete DeNeergard 210-680-3371
Hugo Rodriguez and Rick Tejada 210-824-1272
Coby Allen 210-625-4988
Abe Novy 210-496-0806
Alamo City Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216
Cavender Audi 15447 IH 10 W San Antonio, TX 78249
Cavender Toyota 5730 NW Loop 410 San Antonio, TX
Northside Ford 12300 San Pedro San Antonio, TX
David Espinoza 210-912-5087
Sean Fortier 210-681-3399
Gary Holdgraf 210-862-9769
Wayne Alderman 210-525-9800
Ancira Chrysler 10807 IH 10 West San Antonio, TX 78230
Ancira Nissan 10835 IH 10 West San Antonio, TX 78230
Jarrod Ashley 210-558-1500
Jason Thompson 210-558-5000
GUNN AUTO GROUP
GUNN AUTO GROUP
GUNN Chevrolet GMC Buick 16550 IH 35 N Selma, TX 78154
Ancira Buick, GMC San Antonio, TX Jude Fowler 210-681-4900
Ingram Park Nissan 7000 NW Loop 410 San Antonio, TX Alan Henderson 210-681-6300 KAHLIG AUTO GROUP
Ingram Park Auto Center Dodge 7000 NW Loop 410 San Antonio, TX
Ingram Park Auto Center Mazda 7000 NW Loop 410 San Antonio, TX
Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX
Mercedes Benz of Boerne 31445 IH 10 W Boerne, TX
North Park Subaru 9807 San Pedro San Antonio, TX 78216
Daniel Jex 210-684-6610
Frank Lira 210-381-7532
Richard Wood 210-366-9600
John Wang 830-981-6000
Mark Castello 210-308-0200
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
North Park Subaru at Dominion 21415 IH 10 W San Antonio, TX 78257
North Park Toyota 10703 SW Loop 410 San Antonio, TX 78211
North Park Mazda 9333 San Pedro San Antonio, TX 78216
North Park Lexus 611 Lockhill Selma San Antonio, TX
North Park Lexus at Dominion 21531 IH 10 W San Antonio, TX
Stephen Markham 877-356-0476
Justin Boone 210-635-5000
Scott Brothers 210-253-3300
Jose Contreras 210-308-8900
Justin Blake 888-341-2182
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
North Park Lincoln 9207 San Pedro San Antonio, TX
North Park VW at Dominion 21315 IH 10 W San Antonio, TX 78257
Land Rover of San Antonio 13660 IH-10 West (@UTSA Blvd.) San Antonio, TX
Porsche Center 9455 IH-10 West San Antonio, TX
James Cole 800-611-0176
Ed Noriega 210-561-4900
Matt Hokenson 210-764-6945
Sandy Small 210-341-8841
AUTO PROGRAM
Call Phil Hornbeak 210-301-4367 or email phil.hornbeak@bcms.org
AUTO REVIEW
2017 BMW M2 By Steve Schutz, MD
The 2000-2006 BMW M3, known as the
brace, the new M2.
is made for a manual transmission, by the
E46 to BMW insiders, is widely considered
Based on the 2-series coupe, the M2 is in-
way. If you insist on ordering one with pad-
to be the best M3 ever. Athletic and won-
deed embraceable. Fun to look at but with a
dle shifters please don’t tell me, it’ll just make
derful to drive (unlike its just-OK E36 M3
naughtiness lurking just below the surface,
me sad.)
predecessor), accessible and easy to drive
the M2 really reminds me of the aforemen-
quickly (unlike the expensive and peaky
tioned E46 M3.
On the highway, the M2 is also good, but it’s on windy back roads where it soars. In
first-gen E30 M3), and not completely over
It certainly drives a lot like that car. Nim-
fact, its amazing goodness goes a long way to-
the top (unlike the loud and untamed V8
ble, eager, and fast were the adjectives that
ward explaining why, for the time being any-
E92 M3), the E46 M3 was pretty wonder-
first came to mind when I drove the M2. I
way, the M2 is sold out. Everywhere, not just
ful. For the record, the new M3/M4 siblings
headed out to a windy mountain road as
in the U.S. A long time surgeon/car enthusi-
are pretty wonderful too, but with average
soon as I could, and the M2 gobbled up the
ast friend of mine — and current Porsche 911
transaction prices approaching $80,000,
tarmac with an enthusiasm that made me
driver who’s owned numerous BMWs includ-
those cars’ wonderfulness can’t really be
smile. Wow, is this car great from behind the
ing an E46 M3 — drove my test car and
called accessible.
steering wheel: hold revs through the apex
promptly called her BMW salesman asking
Anyway, the oh-so-sweet E46 M3 of
of a tight turn, accelerate carefully, and then
to buy one. Nope was his reply. We’ll take
many years ago has been missed, and it is
assertively as you hit a straighter stretch of
your deposit and fill out the forms for you,
nice to see BMW — the company that now
road, then brake hard and downshift, taking
but you’re going to have to wait, even if you
sells nearly as many SUVs as cars — choos-
care to match revs, of course, then hit the
do European delivery. Ugh. She’s going with
ing to give enthusiasts a car they can em-
next apex, and do it all over again. (The M2
a new manual 911 instead. Fair enough.
44 San Antonio Medicine • June 2017
AUTO REVIEW
Most of the credit for all that driving sweet-
will care. Still, we’re talking about a car that
trol (ugh no), frontal collision warning and
ness goes to numerous M3/M4 chassis and
costs almost $60,000, so it’s worth noting
mitigation (no), and a lane departure
suspension components the M2 gets, as well
that buyers should focus on the driving ex-
warning system (never).
as its 245 mm front and 265 mm rear high
cellence of these cars, because the mono-
The BMW M2 is an excellent driver's car
performance tires (mounted on 19” wheels).
chromatic black plasticky cabins are
that enthusiasts will enjoy for years, assum-
Of course, a muscular 3.0 twin-scroll tur-
uninspiring, as are the tight confines that
ing they’re lucky enough to find one or don’t
bocharged inline six-cylinder engine that pro-
made me, at 6’2”, feel a little claustrophobic.
mind waiting. It’s a reincarnated E46 M3,
duces 365 HP doesn’t hurt either, as a 4.0
All M2s come with pretty much every-
but probably better. Is it small and does it
thing you want including the aforemen-
have an average interior? Yes, but when you
Design-wise, the M2 is basically a stan-
tioned 19-inch wheels, xenon headlights,
start the engine and drive it you won’t care.
dard issue 2-series coupe with numerous
automatic wipers, keyless ignition and entry,
At all. And that’s what matters.
aerodynamic add-ons to the body which give
leather upholstery, 10-way power (heated)
the M2 more downforce at speed. Not inci-
front sport seats, driver memory settings,
If you’re in the market for this kind of ve-
dentally, those changes to the bodywork also
iDrive infotainment — now actually pretty
hicle, call Phil Hornbeak at 210-301-4367.
give the M2 a menacing look that the more
good and easy to use — satnav, Bluetooth
pedestrian 228i — and even the M235i —
phone and audio connectivity, and a 12-
Steve Schutz, MD, is a
just can’t match. (Prominent M2 badges on
speaker Harman Kardon audio system with
board-certified gastroenterolo-
the front grille and rear trunk lid let other
satellite radio and a USB input.
gist who lived in San Antonio
second zero-to-60 time attests.
drivers know that this is a special car.)
The optional Executive package adds a
in the 1990s when he was sta-
Inside, the M2 is not as special as the
heated steering wheel (yes), rearview cam-
tioned here in the U.S. Air Force. He has been
M3/M4 — or even the significantly cheaper
era (sure, why not), rear parking sensors
writing auto reviews for San Antonio Medicine
320i, for that matter — not that enthusiasts
(no), automatic high-beam headlight con-
since 1995. visit us at www.bcms.org
45
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